Selection bias in general practice research: analysis in a cohort of pregnant Danish women

Ertmann, Ruth Kirk; Nicolaisdóttir, Dagný Rós; Kragstrup, Jakob; Siersma, Volkert; Overbeck, Gritt; Wilson, Philip; Lutterodt, M.C.

doi:10.1080/02813432.2020.1847827

Cited by 7 publications

(10 citation statements)

References 31 publications

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“…We sampled GPs from two representative regions of Denmark, including urban and rural areas, as well as areas with low and high social status and income. This strengthens the geographical and socioeconomic representation, but the GPs could choose not to participate, and the participating GPs might not have asked all eligible women [ 48 ]. While this selection bias may have affected estimates of prevalence, it is less likely to have affected the associations investigated.…”

Section: Discussionmentioning

confidence: 99%

Infant crying problems related to maternal depressive and anxiety symptoms during pregnancy: a prospective cohort study

Ölmestig

Siersma

Birkmose

et al. 2021

BMC Pregnancy Childbirth

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Background Infant crying may cause concerns among new parents and is a frequent reason for seeking help from their general practitioner (GP). The etiology of crying problems in infancy is not fully understood, but recent studies have found associations with maternal mental factors. It is well-established that postpartum depression is related to infant crying problems while the influence of maternal mental problems in pregnancy on infant crying is less investigated. We aimed to explore whether maternal depressive symptoms or maternal anxiety during pregnancy were related to crying problems by the newborn child. Methods In this prospective cohort study, 1290 pregnant women and their newborn children were followed throughout pregnancy until 8 weeks postpartum. Depressive symptoms and anxiety symptoms were assessed three times during pregnancy and again 8 weeks postpartum with the Major Depressive Inventory (MDI) and the Anxiety Symptoms Scale (ASS). Eight weeks postpartum the mothers were also asked whether their child cried in a way they found problematic. Multivariable regression was used to assess the association between depressive and anxiety symptoms during pregnancy and crying problems, and to adjust for potential confounders. Results We found statistically significant associations between high scores of depressive symptoms and anxiety symptoms in pregnancy and infant crying problems. Previously reported strong associations postpartum between depressive symptoms, anxiety symptoms and infant crying problems were also observed in the present data. Conclusion These results indicate that mental problems during pregnancy are associated with having a child with crying problems after birth. If more focus is given to maternal mental problems during pregnancy, the healthcare system might be able to detect and help these women, which would be beneficial for both mother and child.

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Section: Discussionmentioning

confidence: 99%

Infant crying problems related to maternal depressive and anxiety symptoms during pregnancy: a prospective cohort study

Ölmestig

Siersma

Birkmose

et al. 2021

BMC Pregnancy Childbirth

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“…However, the fact that characteristics were overall well balanced between groups indicates that this bias was minimal; we also adjusted for imbalanced variables to mitigate their influence on the estimate. Third, health professionals may have selected compliant participants, thereby inducing selection bias [ 68 ]. However, this limitation would have affected both the intervention and control groups.…”

Section: Discussionmentioning

confidence: 99%

Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial

Adisso¹,

Taljaard²,

Stacey³

et al. 2022

JMIR Aging

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Background Frail older adults and caregivers need support from their home care teams in making difficult housing decisions, such as whether to remain at home, with or without assistance, or move into residential care. However, home care teams are often understaffed and busy, and shared decision-making training is costly. Nevertheless, overall awareness of shared decision-making is increasing. We hypothesized that distributing a decision aid could be sufficient for providing decision support without the addition of shared decision-making training for home care teams. Objective We evaluated the effectiveness of adding web-based training and workshops for care teams in interprofessional shared decision-making to passive dissemination of a decision guide on the proportion of frail older adults or caregivers of cognitively-impaired frail older adults reporting active roles in housing decision-making. Methods We conducted a stepped-wedge cluster randomized trial with home care teams in 9 health centers in Quebec, Canada. Participants were frail older adults or caregivers of cognitively impaired frail older adults facing housing decisions and receiving care from the home care team at one of the participating health centers. The intervention consisted of a 1.5-hour web-based tutorial for the home care teams plus a 3.5-hour interactive workshop in interprofessional shared decision-making using a decision guide that was designed to support frail older adults and caregivers in making housing decisions. The control was passive dissemination of the decision guide. The primary outcome was an active role in decision-making among frail older adults and caregivers, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceptions of how much care teams involved frail older adults and caregivers in decision-making. We performed an intention-to-treat analysis. Results A total of 311 frail older adults were included in the analysis, including 208 (66.9%) women, with a mean age of 81.2 (SD 7.5) years. Among 339 caregivers of cognitively-impaired frail older adults, 239 (70.5%) were female and their mean age was 66.4 (SD 11.7) years. The intervention increased the proportion of frail older adults reporting an active role in decision-making by 3.3% (95% CI –5.8% to 12.4%, P=.47) and the proportion of caregivers of cognitively-impaired frail older adults by 6.1% (95% CI -11.2% to 23.4%, P=.49). There was no significant impact on the secondary outcomes. However, the mean score for the frail older adults’ perception of how much health professionals involved them in decision-making increased by 5.4 (95% CI −0.6 to 11.4, P=.07) and the proportion of caregivers who reported decisional conflict decreased by 7.5% (95% CI −16.5% to 1.6%, P=.10). Conclusions Although it slightly reduced decisional conflict for caregivers, shared decision-making training did not equip home care teams significantly better than provision of a decision aid for involving frail older adults and their caregivers in decision-making. Trial Registration ClinicalTrials.gov NCT02592525; https://clinicaltrials.gov/show/NCT02592525

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“…This study offered a unique opportunity to identify the source population, because almost all pregnant women in Denmark contact their GP in early pregnancy, and first pregnancy consultations are registered in a national database based on reimbursement data provided by GPs 35 . Great effort was put into recruiting and obtaining responses from the pregnant women, and no exclusion criteria were used in recruitment 35 . A recruitment bias might be present, as the GPs might not have recruited all available women, and women who did not read Danish well might not have participated.…”

Section: Discussionmentioning

confidence: 99%

“… 35 Great effort was put into recruiting and obtaining responses from the pregnant women, and no exclusion criteria were used in recruitment. 35 A recruitment bias might be present, as the GPs might not have recruited all available women, and women who did not read Danish well might not have participated. This deviation from a representative sample of pregnant women in Denmark affects prevalence data but should not affect the studied associations between symptoms and outcomes.…”

Section: Discussionmentioning

confidence: 99%

The predictive value of common symptoms in early pregnancy for complications later in pregnancy and at birth

Ertmann

Nicolaisdóttir

Kragstrup

et al. 2022

Acta Obstet Gynecol Scand

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Introduction:The aim was to investigate whether common pregnancy-related symptoms-nausea, vomiting, back pain, pelvic girdle pain, pelvic cavity pain, vaginal bleeding, itching of vulva, pregnancy itching, leg cramps, uterine contractions and varicose veins-in the first trimester of pregnancy add to the identification of women at high risk of future pregnancy and birth complications. Material and methods: Survey data linked to national register data. All women booking an appointment for a first prenatal visit in one of 192 randomly selected General Practices in East Denmark in the period April 2015-August 2016. The General Practices included 1491 women to this prospective study. Two outcomes, pregnancy complications and birth complications, were collected from the Danish Medical Birth Register.Results: Among the 1413 included women, 199 (14%) experienced complications in later pregnancy. The most serious complication, miscarriage, was experienced by 65 women (4.6%). Other common pregnancy complications were gestational diabetes mellitus (n = 11, 0.8%), gestational hypertension without proteinuria (n = 34, 2.4%), mild to moderate preeclampsia (n = 34, 2.4%) and gestational itching with effect on liver (n = 17, 1.2%). Women who experienced pelvic girdle pain, pelvic cavity pain or vaginal bleeding in the first trimester of pregnancy had a higher risk of pregnancy complications later on in later pregnancy. None of the other examined symptoms showed associations to pregnancy complications. No associations were found between pregnancy-related physical symptoms in first trimester and birth complications.Conclusions: Symptoms in early pregnancy do not add much information about the risk of pregnancy or birth complications, although pain and bleeding may give reason for some concern. This is an important message to women experiencing these common symptoms and to their caregivers.

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Selection bias in general practice research: analysis in a cohort of pregnant Danish women

Cited by 7 publications

References 31 publications

Infant crying problems related to maternal depressive and anxiety symptoms during pregnancy: a prospective cohort study

Infant crying problems related to maternal depressive and anxiety symptoms during pregnancy: a prospective cohort study

Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial

The predictive value of common symptoms in early pregnancy for complications later in pregnancy and at birth

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